The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study

Maryam Vasaghi Gharamaleki; Maryam Habibagahi; Etrat Hooshmandi; Reza Tabrizi; Shahram Arsang-Jang; Zohreh Barzegar; Nima Fadakar; Vahid Reza Ostovan; Abbas Rahimi-Jaberi; Nahid Ashjazadeh; Peyman Petramfar; Maryam Poursadeghfard; Sadegh Izadi; Masoumeh Nazeri; Hanieh Bazrafshan; Zahra Bahrami; Sedigheh Karimlu; Seyedeh Shaghayegh Zafarmand; Mahnaz Bayat; Mohammad Saied Salehi; Maryam Owjfard; Saeideh Karimi-Haghighi; Anahid Safari; Banafsheh Shakibajahromi; Beng Lim Alvin Chew; Bradford B G Worral; Jonathan M Coutinho; Carlos Garcia-Esperon; Neil Spratt; Christopher Levi; Mahmoud Reza Azarpazhooh; Afshin Borhani-Haghighi

doi:10.1016/j.jstrokecerebrovasdis.2022.106468

The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study

J Stroke Cerebrovasc Dis. 2022 Jul;31(7):106468. doi: 10.1016/j.jstrokecerebrovasdis.2022.106468. Epub 2022 Mar 25.

Authors

Maryam Vasaghi Gharamaleki¹, Maryam Habibagahi¹, Etrat Hooshmandi², Reza Tabrizi³, Shahram Arsang-Jang⁴, Zohreh Barzegar¹, Nima Fadakar¹, Vahid Reza Ostovan¹, Abbas Rahimi-Jaberi¹, Nahid Ashjazadeh¹, Peyman Petramfar¹, Maryam Poursadeghfard¹, Sadegh Izadi¹, Masoumeh Nazeri¹, Hanieh Bazrafshan¹, Zahra Bahrami¹, Sedigheh Karimlu¹, Seyedeh Shaghayegh Zafarmand¹, Mahnaz Bayat¹, Mohammad Saied Salehi¹, Maryam Owjfard¹, Saeideh Karimi-Haghighi¹, Anahid Safari¹, Banafsheh Shakibajahromi¹, Beng Lim Alvin Chew⁵, Bradford B G Worral⁶, Jonathan M Coutinho⁷, Carlos Garcia-Esperon⁵, Neil Spratt⁵, Christopher Levi⁵, Mahmoud Reza Azarpazhooh⁸, Afshin Borhani-Haghighi⁹

Affiliations

¹ Clinical Neurology Research Center, Shiraz University of Medical Sciences, P.O.Box: 7193635899, Shiraz, Iran.
² Clinical Neurology Research Center, Shiraz University of Medical Sciences, P.O.Box: 7193635899, Shiraz, Iran. Electronic address: ehoshmandi@gmail.com.
³ Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran; Clinical Research Development Unit, Vali Asr Hospital, University of Medical Sciences, Fasa, Iran.
⁴ Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
⁵ Department of Neurology, John Hunter Hospital, Newcastle, Australia; Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia.
⁶ Department of Neurology, University of Virginia, Charlottesville, VA, United States.
⁷ Department of Neurology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherland.
⁸ Stroke Prevention and Atherosclerosis Research Center, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
⁹ Clinical Neurology Research Center, Shiraz University of Medical Sciences, P.O.Box: 7193635899, Shiraz, Iran; Department of Neurology, John Hunter Hospital, Newcastle, Australia; Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia. Electronic address: neuro.ab@gmail.com.

PMID: 35523051
PMCID: PMC8947940
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106468

Abstract

Objectives: There are several reports of the association between SARS-CoV-2 infection (COVID-19) and cerebral venous sinus thrombosis (CVST). In this study, we aimed to compare the hospitalization rate of CVST before and during the COVID-19 pandemic (before vaccination program).

Materials and methods: In this retrospective cohort study, the hospitalization rate of adult CVST patients in Namazi hospital, a tertiary referral center in the south of Iran, was compared in two periods of time. We defined March 2018 to March 2019 as the pre-COVID-19 period and March 2020 to March 2021 as the COVID-19 period.

Results: 50 and 77 adult CVST patients were hospitalized in the pre-COVID-19 and COVID-19 periods, respectively. The crude CVST hospitalization rate increased from 14.33 in the pre-COVID-19 period to 21.7 per million in the COVID-19 era (P = 0.021). However, after age and sex adjustment, the incremental trend in hospitalization rate was not significant (95% CrI: -2.2, 5.14). Patients > 50-year-old were more often hospitalized in the COVID-19 period (P = 0.042). SARS-CoV-2 PCR test was done in 49.3% out of all COVID-19 period patients, which were positive in 6.5%. Modified Rankin Scale (mRS) score ≥3 at three-month follow-up was associated with age (P = 0.015) and malignancy (P = 0.014) in pre-COVID period; and was associated with age (P = 0.025), altered mental status on admission time (P<0.001), malignancy (P = 0.041) and COVID-19 infection (P = 0.008) in COVID-19 period.

Conclusion: Since there was a more dismal outcome in COVID-19 associated CVST, a high index of suspicion for CVST among COVID-19 positive is recommended.

Keywords: COVID-19; Hospitalization rate; Prognosis; SARS-CoV-2; Sinus thrombosis; Stroke.

MeSH terms

Adult
COVID-19* / diagnosis
COVID-19* / epidemiology
Hospitalization
Humans
Middle Aged
Pandemics
Retrospective Studies
SARS-CoV-2
Sinus Thrombosis, Intracranial* / diagnosis
Sinus Thrombosis, Intracranial* / epidemiology
Sinus Thrombosis, Intracranial* / therapy